Thrombosis in the Lymphatic Channels

PATHOLOGY AND BACTERIOLOGY

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PATHOLOGY AND BACTERIOLOGY

UNDER THE CHARGE OP

JOHN McCRAE, M.D., M.R.C.P.,

LECTURER OH PATHOLOOT AND CUH1CAL MEDICINE, MO OILL UNIVERSITY, MONTREAL? BOMB TIUB
' PROVEMOB OF FAYTIOLOOY IN TUB UNIVERSITY OF VERMONT, BUBUNOTON, VERMONT!
fiENIOH ASSISTANT PHYSICIAN, BOTAt VICTOBIA HOSPITAL* MONTBEAL.

The Effect of Salvarsan on the Circulatory and Renal Systems —
Alvebens (Arch. f. exper. Path., 1913, Band lxxii) conducted experi¬
ments upon rabbits, and found that long-continued administration of
salvarsan intravenously brought about a slight nephritis attributable
to the arsenic contained. In the toxic doses, administered during n
short time, marked fall of blood pressure and serious interference
with renal function occurred, but lesions were not visible in the kid¬
neys. If neosalvarsan were administered for a long period, nephritis
was not clinically observed, although definite change could be demon¬
strated in the kidneys. If administered for a short time, the giving
of neosalvarsan was less deleterious to the animals than salvarsan.
If nephritis had been previously excited by cantli(iiid>ii, rabbits showed
marked sensitization to salvarsan, whereas if the nephritis had been
caused by mercury or chromic salts, that is, were essentially tubular,
no ill results were obtained till large doses were employed. Amma s
with aortic and tricuspid incompetence were treated, with the result
that cases of tricuspid insufficiency with resulting congestion of the
abdominal organs bore salvarsan worse than those affected merely
by an aortic leakage.

Thrombosis in the Lymphatio Channels.— Oi-ie (Jour. tied. Re¬
search, October, 1913) details some interesting observations upon
thrombosis and occlusion of lymphatics. Opie points out that in cir¬
culating blood, the blood platelets .perform an. important part by
gathering at the site of an injury to the endothelium, so that fibrin is
deposited upon the mass of platelets. Lymph from the thoracic
ducts, on the other hand, coagulates very slowly because of the small
quantity of thrombokinose present in it; the addition of blood or of
lymph-tissue-ex tract brings about firm coagulation. There is thrombin
present, hut thronibokioaso is deficient. _ It was thought likely that
thrombosis might be produced by direct introduction of tissue-extract
or tissue cells into the lymphatics, and this was done after ligation of
the thoracic duct near its point of entry to the venous system. Tissue
cells or tissue juices introduced into the mesenteric lymphatics will
then produce a prompt thrombosis. It was noticed that in such a
state edema occurs, but that there was a marked tendency to rapid
formation of collateral lymphatic circulation. Further, it was noted
that if occlusion of the duct was produced, followed by injection of
bacteria into the circulating blood, thrombosis m the lymphatics
occurred. A necrosis of cells in contact with the lymph stream favors
thrombosis in the lymphatic vessels, because in this way thrombo-
kinase is brought into contact with the circulating lymph. Bacteria

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PROGRESS OF MEDICAL SCIENCE

are potent in bringing about, this effect, doubtless because they cause
injury of the endothelial cells, and the suggestion i3 made that bacterial
infection is successfully resisted partly by reason of a free flow of
lymph which is rich in bactericidal substance. If the thoracic duct
be occluded, or in fact any large lymphatic trunk, edema occurs which
is relieved by the establishment of collateral circulation. In the
experiments above mentioned, this was brought about in one ease by
formation of a new channel which entered the proximal part of the
ligatured duct, and in another case by collaterals which ran to the
right thoracic duct; while in some cases no such communication
could be mndc out, but the edema was not widely spread. If occlu¬
sion of the thoracic duct and injury of the mesenteric duct be produced,
chylous ascites may occur.

Palseopathology.— Prof. Ruffeii (Jour. Path, and Bad., October,
1913, xviii, No. 2) has coined this unusual word to embrace knowledge
that may be gained as to the inroads of disease upon bodies preserved
to us from ancient times. He has had an opportunity of studying the
pathological lesions in Coptic bodies dating from the fifth century of
the Christian era. The bodies were not mummies in the proper sense
of the word, but owed their wonderful preservation to the dry sand
and to salt. They were evidently for the most part Christians, and
many were dressed in embroidered garments. The teeth were found
very badly diseased; caries .was common; pyorrhea alveolaris and
periodontitis were frequent, and it is evident that little care was
bestowed in life upon the teeth by the Copts; nor was there any evi¬
dence that dentistry was understood by them. Spondylitis deformans
was frequent, usually localized to a few vertebra;. Hypertrophy of
the middle turbinated bones was noted; enlarged spleens, supposed
to indicate malaria, were also found. The histological observations
will be given later.

Tubercle Bacilli in the Feces.—So much has been written about the
presence of acid-fast bacilli in the feces of tuberculous and non-tuber-
culous persons, that it is n little difficult for the casual observer to
know what he should believe with regard to the frequent presence of
tubercle bacilli in the stools. Laird, Kite, and Stewart (Jour. Med.
Research, October, 1913) hnvc undertaken careful experimentation
with a view to clearing up this vexed subject. Many observers have
shown the presence of tubercle bacilli in the stools of tuberculous
people. By some this has been credited to swallowing the sputum,
and by others to the presence of ulcers in the bowels. Many acid-fast
bacilli in the stools of animals and of human beings ill with various
diseases have been reported, and in some cases it has been definitely
stated that these were tubercle bacilli. Tubercle bacilli are sometimes
found in the stools, while none can be demonstrated in the sputum,
while in a large series of casc3 with bacilli in the sputum they were
also capable of demonstration in the stools. A series of eases was
reported in which tubercle bacilli were found in the stools of all of
100 patients who had tubercle bacilli in the sputum, and in more than
20 per cent, of 1000 other persons. The above mentioned authors at
Saranac hnvc examined a large number of persons, and have con¬
cluded that nearly all patients with tubercle bacilli in their sputum